Use of rotablation to rescue a “fractured” micro catheter tip: A case report

Successful Management of a Fractured Microcatheter During Retrograde CTO Intervention

We describe the successful management of a 60-year-old male patient with chronic chest pain, a history of hypertension, and previous percutaneous coronary intervention in the right coronary artery. After initial failure with an antegrade approach, a retrograde approach using a 1.7-F APT microcatheter (Instantpass, APT Medical) and guidewires resulted in the fracturing of the microcatheter within the septal branch. The decision was made to leave the fractured device in situ because of its minimal impact on coronary blood flow. Subsequently, the occlusion in the left anterior descending artery was successfully crossed using a CP 8-20 guidewire, and 2 drug-eluting stents were implanted. The patient had a favorable clinical outcome, with no restenosis or recurrence of symptoms at 12-month follow-up. This case highlights the challenges of chronic total occlusion intervention, particularly device fractures, and underscores the importance of tailored decision making and expertise in managing such complications.

Rotational atherectomy to pulverize a fractured microcatheter tip: Clean up after yourself!

Microcatheter tip embolization is a rare but potentially life-threatening complication of percutaneous coronary intervention. We describe a case of microcatheter tip fracture due to aggressive manipulation in a calcified lesion. Rotational atherectomy was performed to pulverize it. The smaller remnants were then jailed by stenting. This approach might reduce the risk of acute vessel closure by minimizing debris size.

Turnpike Catheter failure, causes and mechanisms: Insights from the MAUDE database

Background

The Turnpike catheters (Teleflex, Wayne, PA, USA) is a microcatheter that was approved by the Food and Drug Administration in November 2014 to be used to access discrete regions of the coronary and peripheral vasculature.

Methods

The Manufacturer and User Facility Device Experience (MAUDE) database was queried for reports of the Turnpike catheters from March 2015 through August 2021.

Results

A total of 216 reports were found during the study period. After excluding duplicate reports (n = 21), our final cohort included 195 reports. The most common failure mode was catheter tip break or detachment (83%, n = 165) which was significantly associated with over-torquing (p-value = 0.025). The most common clinical consequence was the entrapment of the catheter (33%, n = 65), followed by vessel injury (7.8% n = 15) and vessel occlusion (3.6%, n = 7). Most patients had no consequences (47.0%, n = 93) or recovered (11%, n = 22). A total of 4 deaths were reported. 35.8% of reports (n = 69) specified the presence of severe calcification in the target vessel. Over torquing by interventionists was reported in 33.2% of events (n = 64).

Conclusion

Despite clinical trials demonstrating the safety of the Turnpike catheters, complications can still occur. These data serve to inform operators about potentional risks and complications associated with the use of the device. Physicians should avoid over-torqueing which seems to be the most common mechanism for device complications.

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The Turnpike catheters (Teleflex, Wayne, PA, USA) is a microcatheter that was approved by the Food and Drug Administration in November 2014 to be used to access discrete regions of the coronary and peripheral vasculature.

•

Despite clinical trials demonstrating the safety of the Turnpike catheters, complications can still occur. These data serve to inform operators about potential risks and complications associated with the use of the device.

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Physicians should avoid over-torqueing which seems to be the most common mechanism for device complications.

Device entrapment during percutaneous coronary intervention

INTRODUCTION

Device entrapment is a life-threatening complication during percutaneous coronary intervention (PCI). However, the success for its management is predominantly based on operator experience with limited available guidance in the published literature.

METHODS

A systematic review was performed on December 2021; we searched PubMed for articles on device entrapment during PCI. In addition, backward snowballing (i.e., review of references from identified articles and pertinent reviews) was employed.

RESULTS

A total of 4209 articles were retrieved, of which 150 studies were included in the synthesis of the data. A methodical algorithmic approach to prevention and management of device entrapment can help to optimize outcomes. The recommended sequence of steps are as follows: (a) pulling, (b) trapping, (c) snaring, (d) plaque modification, (e) telescoping, and (f) surgery.

CONCLUSIONS

In-depth knowledge of the techniques and necessary tools can help optimize the likelihood of successful equipment retrieval and minimization of complications.

Management of Microcatheter Fracture in Complex Percutaneous Coronary Intervention With Laser Atherectomy

BACKGROUND/OBJECTIVE

Microcatheters and dedicated guidewires for both chronic total occlusion (CTO) and non-CTO percutaneous coronary intervention (PCI) are increasingly being used to overcome complex coronary anatomy with severe tortuosity and calcification. In extremely resistant lesions, a potential over-rotation and device fatigue may result in entrapment or even fracture causing abrupt vessel closure and hinder successful revascularization.

METHOD/RESULT

We demonstrate two consecutive cases complicated with dislodged microcatheter tip which was rescued uniquely with coronary laser atherectomy. We describe an algorithmic approach for management of microcatheter fracture which are increasingly occur in contemporary practice of complex PCI.

CONCLUSION

In summary, our cases illustrate the feasibility of using coronary excimer laser system to release fractured and entrapped intracoronary MC tips when other conventional percutaneous techniques fail.